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In closed wedge distal femur osteotomies for correction of valgus malalignment overcorrection of mLDFA should be avoided

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The purpose of the study was to investigate the influence of the mLDFA (mechanical lateral distal femur angle) as a parameter in varus realignment osteotomies for valgus deformities of the knee. We hypothesized that joint line obliquity with mLDFA > 90° after distal femur osteotomy (DFO) is associated with inferior clinical outcome.

Methods

In a retrospective study, a total of 52 patients with isolated femoral valgus deformities were included in the study. The mean postoperative follow-up was 70.5 (SD 33.3) months (standard deviation SD±33.3). In all patients, a distal femur osteotomy was performed. A clinical examination and survey of questionnaires was conducted with the HSS (Hospital for Special Surgery), LG (Lysholm-Gilquist), and KOOS (Knee Injury and Osteoarthritis Outcome Score) scores. Several radiological parameters were assessed on long-standing x-rays: mechanical tibio-femoral angle (mTFA), mLDFA, mechanical medial proximal tibia angle (mMPTA), joint-line convergence angle (JLCA). The t test was used for normally distributed data. The Mann-Whitney U test was performed in non-normally distributed data.

Results

The mLDFA was 84.9° (SD±2.3) preop and changed to 91.9° (SD±3, 22.9) postop. The mTFA (mechanical tibio-femoral angle) was 5.2° (SD±2.9°) preop and − 1.8° (SD±2.9) postop demonstrating a difference of 6.7°. For analysis, the data was divided into two groups based on postop mLDFA. Group 1: mLDFA ≤ 90°; Group 2: > 90°. Postoperatively, a mean mLDFA of 88.6° (SD±1.4°) was measured in group 1 and 93.9° (SD±2.1) in group 2. The change in mLDFA was 4.7° (SD±1.6) in group 1 and 8.4° (SD±2.8) in group 2. Preoperatively, the mTFA was 4.8° (SD±1.9) in group 1 and 5.5° (SD±3.3) in group 2. Postoperatively, the mTFA decreased in group 1 by 4.8° (SD±2.3) to − 0.1° (SD±2.1). In group 2, the mTFA decreased by 8.2° (SD±3.8) to − 2.8° (SD±2.9). Regarding the HSS, group 1 showed a 10.4 points better score than group 2 (p<0.01). Also, regarding the Lysholm, a significant difference of 16.9 points was found (p<0.01).

Conclusion

Correction of valgus knees using closed wedge DFO leads to good clinical results. A postoperative mLDFA of 85–90° results in superior clinical outcome compared to mLDFA > 90°. Joint-line obliquity should be avoided using double level osteotomy, if needed.

Level of evidence

III.

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Data availability

The paricipants of this study gave written consent for their data to be shared publicly.

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Funding

The study was performed without any funding.

Author information

Authors and Affiliations

  1. Department of Orthopaedics and Traumatology, Diakonie Klinikum GmbH Jung-Stilling, Siegen, Germany

    Steffen Schröter

  2. Department of Orthopaedics and Traumatology, Helios Hanseatic Hospital Stralsund, Stralsund, Germany

    Christian Konrads

  3. Medical Faculty, University of Tübingen, Tübingen, Germany

    Christian Konrads

  4. Shoulder Unit Villa Stuart Clinic (Rome) Orthopedics, Rome, Italy

    Marco Maiotti

  5. Department of Trauma and Reconstructive Surgery, BG Klinik, University of Tübingen, Tübingen, Germany

    Moritz Mederake, Cornelius Fischer & Marc Ahrend

  6. Department of Orthopaedic Surgery, University of Tübingen, Tübingen, Germany

    Daniel Schüll

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  1. Steffen Schröter
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  2. Christian Konrads
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  3. Marco Maiotti
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  4. Moritz Mederake
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  6. Marc Ahrend
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Contributions

SS: had the idea of the study. He performed the surgery of the majority of the patients. He developed together with DS: the study protocol. Moreover, he was involved in the data analysis and correction of the manuscript. CK: was involved in writing the manuscript and data analysis. He corrected and revised the manuscript. MM: made corrections of the manuscript and was involved in data analysis as well as literature review. MM: wrote part of the manuscript and made review of the literature. CF: was involved in data analysis and manuscript draft. DS: made the data analysis and statistics. I was involved in the manuscript draft.

Corresponding author

Correspondence to Steffen Schröter.

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Conflict of interest

All authors have no conflicts of interest.

Ethical approval

The ethical committee of the University of Tübingen, Germany, approved the study (636/2016BO2).

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All patients confirmed their participation by a signed informed consent.

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Schröter, S., Konrads, C., Maiotti, M. et al. In closed wedge distal femur osteotomies for correction of valgus malalignment overcorrection of mLDFA should be avoided. Knee Surg Sports Traumatol Arthrosc 31, 3992–3999 (2023). https://doi.org/10.1007/s00167-023-07449-1

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